06 February 2019

Rehabilitation of three elements with three CSR implants of different neck morphology - a clinical case

Giuseppe Pellitteri

A 40-year-old female patient with third-degree furcation on the element 1.6 and severe bone resorption of the elements 1.4 and 1.5 which caused third-degree mobility. The patient was treated in two surgical times at a distance of about a year and a half from each other. Due to the young age of the patient and in favor of simplification of oral hygiene, the rehabilitation provided for the insertion of an implant and a crown for the replacement of each missing element.
In the first surgical phase a conservative extraction of the natural alveolus of the element 1.6 was carried out and a sinus lift, followed by the insertion of a CSR Wide Neck implant.
The second surgical phase involved elements 14 and 15, which were extracted and immediately replaced with two CSR implants - Sweden & Martina: Straight Neck and Reduced Neck.

The clinical phases are illustrated below

Figure 1: Occlusal view of the elements 1.4, 1.5, 1.6
Figure 2: Endoral rx in which the forcation of element 16 is highlighted
Figure 3: Conservative extraction of the natural alveolus, in which the crown is divided into three parts in order to maintain the residual bone anatomy and the interradicular septum
Figure 4: element 1.6 after extraction
Figure 5: The interradicular septum is prepared with burs to make a sinus lift
Figure 6: The collagen and then the graft material are inserted inside the septum
Figure 7: A CSR ø 3.80 mm Wide Neck implant is inserted into the alveolus
Figure 8: Occlusal view after implant placement (afterwards the site was covered with a periodontal wrap for a week)
Figure 9: Endoral rx after implant placement
Figure 10: The site is left to heal by second intention. This photo shows the healing of the site after 2 weeks of surgery
Figure 11: This photo shows the healing of the site after 4 weeks of surgery
Figure 12: This photo shows the healing of the site after 8 weeks of surgery. It is possible to appreciate the soft tissue volume gain
Figure 13: Four months after surgery, the site has completely healed and the impression is taken
Figure 14: After taking the impression and developing the model, the prosthesis is designed with Exocad software
Figure 15: The crown made with CAD/CAM system is tested on a model
Figure 16: Screwed prosthesis made with CAD / CAM system at the time of delivery
Figure 17: Endoral Rx at the time of crown delivery
Figure 18: It is possible to notice the growth of the papillae around the crown after two months
Figure 19: Endoral Rx after two months
Figure 20: As shown in the Rx, in the second surgical phase both the extraction of the element 14 (a CSR ø 3.80 mm Straight Neck implant is inserted) and the extraction of the element 15 (a mini sinus rise is carried out and a CSR system ø 4.20 Reduced Neck)
Figure 21: Temporary and polished PEEK temporary posts are screwed to the implants
Figure 22: Vestibular image of screw-retained temporary crowns, delivered the same day of surgery
Figure 23: At 5 months from the surgery the impression is taken with Pick-up transfer
Figure 24: Delivery of the final crowns after 1 month. it is possible to notice the excellent state of health of the soft tissues
Figure 25: Rx of control: on the element 16 it is possible to note the completion of the implant integration, while on the elements 14 and 15 the good bone growth around the three different neck morphologies is visible

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